Doctoring & Healthcare

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Read The Label And Know What Is In OTC Medicines

Quick reminders as we tidy our lives at the beginning of the school year. With little ones and children all heading back to school, we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the fall is upon us, it’s a great time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, and organize the cupboard! In some ways it’s combination medicines that make me worry the most — so this is a quick review on what you can do to feel confident when dosing and using OTC medications at home with your family.

Reading Over The Counter Labels & Dosing Liquid And Children’s Medicine:

1. Read the label.  Plain and simple get in the habit of always reading it as we don’t want to forget to make sure we really know what ingredients we’re giving and why. No question that sometimes we use medicines to “cure” children of illnesses, infections, or deficits (prescription antibiotics, anti-infectives, chemotherapy) but most OTC medicines only treat symptoms our children experience from infections or injuries. That makes them less necessary, although sometimes wildly helpful and soothing. Treating pain and discomfort is of course a priority for all parents when our children are uncomfortable! Consequently, we want to use OTC when they earnestly help and match the correct medicine with the symptom we’re targeting…the label can help.

reading labels 2

2. Know the ingredients — watch out for double dosing! So many products out there have combination medications. Many medicines for cough and cold will combine medicines for fever with medicines for mucus with medicines for cough. Some medicines combine medicines for allergy symptoms with medicine for fever. You might inadvertently be giving your child a second dose of acetaminophen (AKA “Tylenol”) when using a combination medicine without knowing it. Expert toxicology and pediatric emergency room friend, Dr. Suzan Mazor reminds, “that sneaky acetaminophen shows up in all sorts of combination medicines” so watch out! If you’re dosing acetaminophen for fever make sure you’re not double dosing if you’re also treating other symptoms with medicine.

3. The syringe or dosing cup -KEEP IT! Keep the dosing devices that comes with the OTC medicine you buy (use a rubber band as needed to attach it to the bottle)! No question that it is confusing to dose medicines based on weight. In the past, data finds that 98% of liquid OTC medications for children have inconsistencies, excess information, or confusing dosing instructions — thankfully this is changing and there is national push to have pediatricians write and explain doses only in milliliters or milligrams as opposed to dosing and explaining in “teaspoons” and “ounces.” As we work to standardize this there will still be some confusion.

TIP: Never use a “teaspoon” from the drawer to measure medicines and don’t let Grandma or a babysitter. Different teaspoons hold different amounts. Dosing devices typically measure in either milliliters or ounces, so always use the tool that came with the medicine you’re going to give a baby of young child. If you’re ever confused reach out. Using the dosing device that comes with the medicine will help ensure you won’t have to make conversions (mL –> ounces or milliliters to teaspoons) and you can follow instructions on the label more precisely. Dosing by weight (like we do for children) is very different than dosing by age (like we do for adults).

Know Your OTCs have created a few easy-to-read image to help better explain OTC labels. I’ve included a few below, but you can view them all here.

reading labels 3  reading labels 5

 

5-13 know your OTCs

This post was written in partnership with KnowYourOTCs.org. In exchange for our ongoing partnership helping families understand how to use OTC (over-the-counter) meds safely they have made a contribution to Digital Health at Seattle Children’s for our work in innovation. I adore the OTC Safety tagline, “Treat yourself and your family with care all year long.” Follow @KnowYourOTCs # KnowYourOTCs for more info on health and wellness.

6 Ways To Help An Anxious Child

No question it’s tough to keep our cool when our children are unraveling. It’s especially a challenge when our children are rattled and over-run with anxiety. I partner with parents on a weekly basis who feel their children are anxious. All of us want support in knowing just what TO DO in helping our children thrive while also not letting them suffer.

I partnered with Dr. Kathy Melman on the podcast to review tips and strategies for parenting when children are anxious or when our children suffer from anxiety. Dr. Melman is wonderfully steady and clear in knowing what we can do when we find ourselves amid a sea of anxiety. Dr. Melman explains how to improve the environment for our children, what we can do for ourselves as parents to protect our children, and how to help our children not only cope but thrive in the face of anxiety, disruption, fear, and challenge. Listen in and read her 6 tips below. Number four is a BIGGIE…

6 ways to Help Your Anxious Child:

  1. Modeling Matters: If a parent struggles with anxiety—get evidence based cognitive behavioral therapy (CBT) treatment with an adult anxiety specialist. Caring for your own anxiety will limit how your child models undesired behaviors.
  2. Intervene early and effectively! If your child shows signs of anxiety that is causing distress and/or interfering with functioning, seek CBT treatment with a child anxiety specialist. Don’t wait years for help because untreated anxiety can lead to problems including possible school refusal, lack of friends and opportunities to develop social skills, limited development of independence, healthy sleep patterns, lack of involvement in activities outside of the home, substance use and depression as one’s life shrinks with loneliness, low self esteem (“I can’t handle this”) and lack of building mastery. Anxious children often don’t get the help they need and when they do, they have often already suffered for years, other problems have developed, and they often don’t get the most effective, evidence based behavioral treatment.
  3. Acceptance and Empathy: Accept if your child is “wired together” to have more anxiety and be empathic, rather than invalidating, of their experience. Taking the moment to accept their feelings (even when they seem outlandish!) will allow you to both acknowledge and then support your child more effectively.
  4. Don’t Permit Avoidance: It is really hard to see your child suffer and parents often, meaning well, allow their child to escape and avoid anxiety provoking situations. As a parent, it is important to learn to tolerate this distress, remain calm and know that permitting escape and avoidance and providing excessive reassurance only strengthens anxiety, reinforces your child’s thoughts that the world is a scary place and the belief that they aren’t capable of coping effectively. This is an important dance parents often do with their anxious children and it is critical to change this pattern.
  5. Reward Brave Behavior: Instead of paying attention to anxious behavior, reward use of anxiety management skills (recognizing when anxious, which situations trigger anxiety, what happens in your body, what are your thoughts, calming your body, challenging unrealistic, catastrophic thinking with checking the facts to develop more realistic thinking along with coping and calming thoughts, and approach feared situations in a gradual, manageable, step by step fashion). We are asking our children to do what terrifies them so provide them with empathy, support, skills and coaching so they overcome anxiety by facing their fears and learning that they can, in fact, do this, nothing terrible will happen, and they can live a full life that is not limited by anxiety. Rewarding use of skills and facing fears (known as exposure) helps your child do what is challenging. Exposure is the most important ingredient in effective treatment of anxiety.
  6. Be Involved in your Child’s CBT Anxiety Treatment: Parental involvement is critical for many reasons including learning about anxiety disorders and their treatment, learning which parenting strategies increase and which decrease child anxiety, learning to coach your child in use of anxiety management skills in challenging moments, not permitting the dance of avoidance, modeling use of skills and brave behavior, learning to tolerate when your child is experiencing distress and responding with empathy and approach, providing many opportunities for exposures and rewarding brave behavior. Parents can also use their understanding of anxiety disorders and their effective treatment to communicate important information with schools, coaches, grandparents and other involved caregivers and settings.

No Nasal Flu Vaccine This Year: Flu Shot For All Over 6 Months

 

Summer vacation has just started and it feels like the mild 2015-2016 flu season just ended. Here we are already hearing about new recommendations for the 2016-2017 season. Big news in the media today about flu vaccine: recommendations to only offer the shot (and no nasal flu spray) to improve children’s and public protection from the vaccine. Hundreds of children in the US die each year from influenza. We know the best way to protect against complications from influenza is to have families immunized. Flu vaccine is an every-year, essential vaccine as the strains included in the vaccine shift each year based on the types of flu predicted to spread across North America.

Recommendations For Pediatricians And Family Practitioners: Only Flu Shot For Families

Yesterday The American Academy of Pediatrics (AAP) endorsed the Advisory Committee on Immunization Practices (ACIP) recommendations to AVOID use of flu mist vaccine this coming flu season.  The Centers for Disease Control (CDC) will review the recommendations shortly; if CDC accepts the recommendation it will become official US policy.

We all want choice with vaccines and the nasal spray was a great option and a safe one. It was particularly effective during the 2009 H1N1 pandemic flu season and has been safe and very well received (no poke!) by families ever since for children over the age of 2. However, data from the past three years have found that it has been less effective in protecting children and their families from the most common strains of flu circulating (more below).

The nasal flu spray vaccine is still licensed and still safe. Because of recent data, this year to improve protection, ACIP is recommending only using the injected flu shot because it is far more effective at protecting against the strains of flu expected to arrive in the US.

That means a needle and quick poke for our kids. I talked to the TODAY Show about the recommendations this morning. I also talked with influenza and vaccine experts. Read full post »

Frozen Food Recall Because of Possible Listeria

frozen vegetablesBig recall, worth a glance from a frozen food company out of my home state of Washington. The Food & Drug Administration (FDA) issued a recall of 42 brands that sell frozen fruits and vegetables. It’s a BIG list of products that could be in your freezer if you shop at places like Costco, Trader Joe’s or Walmart. This is especially true if you’re pregnant, are immunocompromised or have young children. The possible contamination in these frozen foods is a bacteria called Listeria that can cause more significant illness in those groups. The recall includes over 350 products, both organic and non-organic, which are sold between these 42 brands. The Centers for Disease Control (CDC) notified the company that 7 people from 3 states have become ill and were hospitalized due to listeria, likely stemming from the consumption of contaminated frozen fruits and vegetables.

The FDA has a complete list of brands and products that are being recalled. Note that this recall affects all 50 states. All affected products have the best by dates or sell by dates between April 26, 2016 and April 26, 2018.

The bottom line: check your freezer for frozen fruits and veggies and then check the FDA’s list!  Throw out frozen fruits and vegetables if they are on the list. You can go back to the store where you purchased them and ask for a refund. Keeping them in your freezer is certainly not worth the risk of a Listeria infection. Children who ate contaminated foods and have normal immune systems are not at high risk of listeriosis, and no special testing is needed. Also, foods eaten more than 2 weeks ago are not worrisome, as the incubation period is 1-14 days.

What Is Listeria?

  • Listeria is a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes.
  • Common symptoms include fever and muscle aches, sometimes preceded by diarrhea or other gastrointestinal symptoms (vomiting). Most of us do okay after getting listeria and heal up without intervention but some people can have bigger risks (see below).

Who Is At High Risk:

Read full post »

Join In On The Seattle Mama Doc Podcast?

Always a work in progress here — trying to think on ways to share new data, expert advice & enjoy the journey of parenthood. I’m excited to announce we’re going to pilot a Seattle Mama Doc Podcast early next month. Since this blog’s inception in 2009 we’ve covered nearly 650 standard blog posts, vlogs, guest contributors, interviews and now I’m going to test out a podcast. I am a huge fan of crowd sourcing and co-design, so will you help create the look, feel and content of the podcast alongside me? I would love to know what topics you’re interested in, which you’re tired of hearing about, who you want me to interview and frankly, anything else you’d like to share.

My hope is to interview experts and researchers here at Children’s, parents, and patients when there’s interest in sharing the experience of raising children. We’ll include the smarts of friends and peers across the country working on preventing and preventing illness while raising children. We’ll highlight all the tips and tools we learn along the way, new evidence, expert opinion and ideas to feel better about our decisions while raising our children.

I’ve recorded 3 options for the introduction of my podcast (I’m well aware of kind of bootleg smartphone audio quality for these little demos — promise to record high quality content in studio for the actual podcast).

Which resonates and makes you want to tune in?

Tell me what to cover. And also, would you want to join me on the podcast? SAY SO, PLEASE!

Option #1

 

Option #2

 

Option #3

 

No Controversy, No Censorship — When Tribeca Got It Right

Screenshot 2015-02-01 12.30.40We don’t know what causes all autism but we do know vaccines don’t. Continuing to elevate myth does NO ONE any good. That’s why the Tribeca Film Festival got it right when pulling a documentary written and co-directed by vaccine science villain, Dr. Andrew Wakefield. Giving him another platform and more voice just isn’t insightful. To me it’s more noise and less what we need. There isn’t controversy here and there isn’t anything new to uncover. Allowing Wakefield more air time and the catapult generated by a film festival just ISN’T going to help us perfect parenthood and it won’t improve our jobs protecting our families, our children, and our communities. The Injustice of Immunization Interviews continues…

Tribeca Film Festival And Vaccines:

Wakefield is a doctor whose work connecting vaccines to autism was retracted from a medical journal (this is nearly UNHEARD of) and a doctor who lost his license to actually practice medicine. He’s not respected nor is his work something for us to learn from. His work may go down as one of the biggest frauds in medical history. Read: Wakefield’s article linking MMR to autism was fraudulent.

The science, on the other hand, is clear and well established. Vaccines have repeatedly and repeatedly been studied with respect to development of neurodevelopment changes and diagnoses on the autism spectrum. Don’t believe the preposterous things the politicians say. The 2011 comprehensive and enormous report from The Institute of Medicine analyzed over 1,000 studies on adverse side effects from vaccines. They concluded, “the evidence shows there are no links between immunization and some serious conditions that have raised concerns, including Type 1 diabetes and autism.” (read more here)

Ongoing research, motivated primarily because of the distrust and fear for vaccine safety propagated in movies, media, and documentaries alike continue to find the very same thing. Science continues to come out on the side of vaccines. Vaccines have adverse effects (fever, pain, seizure, and fainting, for example) but not autism. Read full post »

New Birth Control Laws: Preventing Unplanned Pregnancy

Birth ControlEasy, confidential access to affordable birth control is essential if we’re going to decrease the rate of unplanned pregnancies. The dynamics of birth control access are changing, thank goodness. As we’ve heard about parts of the world simply telling women NOT to have babies (Hello, Ecuador) we really do have to think about how women and men prevent pregnancy when not ideal. And how we support women getting information they need to make the safest and most reliable choice. This can start way before teens are sexually active.

Things are changing here in the US. As of Jan. 1, 2016 women 18 and older in Oregon can get hormonal contraceptives directly from a pharmacy, without having to go to a doctor for a prescription first. Pharmacists who supply birth control are required to complete formal training before being allowed to write prescriptions. In addition, teens and women must take a 20-question health assessment before obtaining the prescription that details risks and family history. This is why I always want parents to tell their teen if there is a family history of blood clots, family history of migraines, etc. That way, they can answer correctly!

The good news, here in the US, contraception is covered by insurance and protected by Obamacare (Thank you, Mr. President). Birth control options covered by the Affordable Care Act include: IUDs, emergency contraception, implants, pills, patches & rings.

California has also passed similar legislation that will take effect in the coming months to make it even easier for women to access birth control. National work is ongoing as well to make birth control over-the-counter. More on that to come!

When it comes to teaching our teens about sexual education, we know the topic is fraught with contentious beliefs and cultural sensitivities, and we also know that it’s really hard to speak about certain topics openly. But over and over, we are told by our kids that it’s us – the parents – their trusted adult community – they want to hear from most. Even when they squirm in the seat, DO KNOW THEY ARE LISTENING. I’ve written about this before for parents preparing those kids going off to college.

But really, talking to your teens about how to protect their bodies from sexually transmitted diseases, unplanned pregnancies, or violence should start much earlier. Normalizing the conversation appropriately for kids as young as five is encouraged in many parts of the world. We can talk about how we time growing our families in age-appropriate contexts. I’m thinking of writing a post, in partnership with a health educator, about what to say to a 5 year-old, an 8 year-old, an 11 year-old, and a 15 year-old. Would that be helpful? Please leave a comment…

I also want to offer a few great resources, thanks in part to my friend, teen advocate and digital educator, Susan Williams (@estherswilliams) for other parents to use as additions to or as guides for helping their kids understand their bodies and their decisions when it comes to sex and relationships.

There are three initiatives underway that I believe are truly shifting how sexual education and access to the right care, contraception, and information is achieved. Being able to get the right information when you need it and then being shown how to act on that information is crucial to preventing unplanned pregnancies and reducing cases of STDs. For adults who love their (our!) kids, we also need resources to help guide how we talk about sex:  Read full post »

Yes To No Tobacco Until Age 21

Teen smokingHear me straight: we don’t want anyone addicted to tobacco products. No question it’s an ugly habit and a terribly complex addiction. Expensive, detrimental to health, so very ugly… So I’m all for WA State House Bill 2313 (SB 6157) supporting moving the purchase age of tobacco from 18 to 21. Yes I know you can vote and enlist in the military at 18, but inconvenient or not, teen brains are not fully developed by the time they enter college-age and the effects of nicotine and the trend towards lifelong addiction are seriously grim. Complain all you want that Washington would be a “nanny state” but the facts are clear: if you start smoking at a young age, odds are that you will still be smoking as an adult. We know that more than 80% of all adult smokers begin smoking before the age of 18; and more than 90% do so before leaving their teens. We need to get tobacco out of reach so we can stop addiction before it starts. This isn’t just about public health it’s also about the health care spending of your tax dollars.

My friend and colleague Dr. John Wiesman (WA Secretary of Health), gave a press conference this week on the new bill. Here are a few staggering excerpts from his speech:

Counting cigarettes, smokeless tobacco, and e-cigarettes together, in 2012, 12 out of every 100 10th graders used these products, and by 2014 that number had risen to 20 out of every 100. That’s a frightening 67%  jump in just 2 years!

Both cigarettes and e-cigarettes set kids up for a lifetime of addiction and poor health.

The most effective way to stop this trend is to stop our kids from smoking before they start.

Middle school, high school and college students are still undergoing significant brain development.

Nicotine exposure during this critical time appears to affect the structure and function of the brain and may lead to lasting cognitive and behavioral impairments.

If that’s not enough reasons to support this work, I don’t know what is. But, here’s one last piece of data that will hit you square in the wallet (ouch). Each year in Washington alone, we spend: Read full post »

10 Reminders And Updates to Pediatric Check-Ups

Pediatric Wellness Visit

Prevention is genius medicine. By making smarter choices, detecting risk early, not only do we improve our quality of life, but we can prolong people’s lives. Pediatrics is the perfect place to master this. Because of the incredible opportunity we have to prevent injury and illness during a person’s childhood, the American Academy of Pediatrics (AAP) updates and refreshes their schedule of recommended screenings and guidelines for wellness visits every year. It’s put into a huge “periodicity table,” basically a chart that reminds us all what to do when. This year some of the recommendations are making headlines. I’ll explain reminders about what you should expect from wellness visits, include all the new updates, and explain a bit more about a couple of the new recommendations (HIV screening for all teens 16-18) in these 10 tips:

  1. Vision: annual, regular vision screening is important. Pediatricians evaluate vision from day one but your child should stand in the hall and screen vision formally at age 4 years (at 3 is great if they can follow directions!) and yearly until  age 6, and then every two years. At age 18, the vision screen will only be given to those at risk or who flag concerns.
  2. Oral Health: an oral exam from physician or dentist is a must at the time of baby’s first tooth eruption. This year, the AAP also endorses that pediatricians provide annual fluoride varnish to children between 6 months – 5 years to reduce cavities.
  3. Drugs & Alcohol: CRAFFT (Car, Relax, Forget, Friends, Trouble) tool will be used to screen adolescents for drug & alcohol use. This screening tool is used to help teens share ways they use alcohol or drugs and identify any risks. Writing it down can help teens share information that may be hard to talk about and the recommendation to formalize this and build this into our electronic health records so it is captured each and every time is smart.
  4. Depression: all children ages 11-21 will be screened for depression. Screening can be done through a combination of filling out survey questions and also questions we ask teens and their families directly. Suicide is a leading cause of death among adolescents — picking up depression or sadness, intervening with counseling, social support, and sometimes medication is essential for supporting teens without proper treatment or support.
  5. Cholesterol: the AAP recommends a blood test will be given to patients between age 9 and 11 universally to screen for elevated blood cholesterol and other blood fats. Because 1/5 children between 12 and 19 have one or more abnormal lipid level, screening is a way to pick up those we don’t suspect. The reason for recommendation is this: atherosclerosis (cholesterol sticking to the insides of your arteries) begins in childhood and accumulates throughout our lives. The more atherosclerosis, the more your risk of a heart attack or stroke. Because heart disease is the #1 killer of both men and women, PREVENTING the accumulation in childhood can potentially lower lifelong risk. If children have a family history of high cholesterol, early heart disease or death in the family (under age 55 years) are obese or have other underlying health conditions like diabetes, children will be screened even earlier (between age 2 to 5). With no risk factors, all children should be screened once between age 9 to 11. The original policy and statement with this recommendation came out in 2011 and I’ve picked up children with elevated cholesterol since. I’m thankful for this recommendation!
  6. Development & Autism: developmental screenings will happen at all ages and all wellness visits. Formal autism screenings will occur at 18 months and the 2-year check up. No changes to this schedule this year.
  7. HIV: every teen age 16-18 should be screened for HIV regardless of sexual activity. In years before 16, and after 18, this is based on risk, social history, exposures. But the reason for screening teens universally is help children know their HIV status, keep them negative, and ensure we’re picking up HIV early when it’s unexpected for early treatment. The facts behind this recommendation:
    1. 1 in 4 new HIV infections occurs in youth ages 13 to 24
    2. 60% of all youth with HIV do not know they are infected
  8. Pap smear & HPV: doctors and nurses will do internal gynecologic exams if any concerns (pain, unusual discharge, menstrual cycles concerns, sexually transmitted disease exposure or diagnosis) but will wait to do a pap smear and HPV testing as screening to look for the presence of pre-cancerous cells on the surface of the cervix, at age 21. Here’s a video where I explain recommendations for “well-women and well-girl” gynecologic exams.
  9. Newborns: AAP recommends all babies get screened for heart disease by auscultation of the heart using a stethoscope and ALSO by using pulse oximetry before leaving hospital or in the first 3-5 days of life.
  10. Growth & Nutrition: your child’s doctor should show you and teach you at EVERY VISIT how your child is growing. They should review their height and weight gain as well as their BMI (or weight/length at young ages) at every visit. Growth is a great marker of thriving health and concerns around growth can really help change a child’s live.
    1. 1/2 of parents underestimate their children’s weight so it’s important to review the numbers every year as they sometimes surprise. 1/3 of children in US are overweight or obese and knowing this early can provoke big changes.
    2. AAP recommends toddlers be checked at 15 and 30 months for iron deficiency — iron is not only important for building strong blood it’s essential to support proper development.
    3. Supplemental Vitamin D also very important for infants and children — 400 IU typically recommended for all infants and children, every day. Ask your pediatrician or family doc for more information.

Read full post »

No Kitchen Spoons! Correct Medication Dosing

OTC Dosing Image

Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools sometimes making it confusing for parents to ensure we are giving our children the proper dose. To add to the confusion, sometimes the recommended dose is written with different units (mLs, mg, or teaspoons) than the dosing device. For example, the box might have dosing in “teaspoons” and the measuring device be divided up into milliliters. This issue is not new but guidelines and protections around the problem are increasing. A win!

This has concerned me for a long time. To drive this point home even further, I gave a dosing conversion quiz on my blog to my colleagues in medicine (also parents) who even struggled to get the dosing correct. The dosing struggle is REAL to non-pediatric docs and parents everywhere.

For example, you may even see differences in devices that would seem to be standard across medications. The dropper that comes with liquid acetaminophen may look very different than the dropper that comes with liquid vitamin D or infant multivitamins. And remember, the most important way to avoid a dosing error is to keep the original dosing device with the actual OTC medication. Read full post »